Healthcare Provider Details

I. General information

NPI: 1811722630
Provider Name (Legal Business Name): NATALIE AGUILAR VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE D
MODESTO CA
95350-5814
US

IV. Provider business mailing address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: